56918_CH01_Secondpass.qxd:Tan 3/18/09 2:57 PM Page 1 PART I Foundation Concepts of Health Management Information Systems © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 56918_CH01_Secondpass.qxd:Tan 3/18/09 2:57 PM Page 2 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 56918_CH01_Secondpass.qxd:Tan 3/18/09 2:57 PM Page 3 CHAPTER 1 Health Management Information Systems: A Managerial Perspective Joseph Tan CHAPTER OUTLINE Scenario: Key Trends Contributing to the Merging of Enterprise and Health Information Exchange Models I. Introduction II. Evolution of HMIS III. HMIS Components and Basic Functions ● HMIS Components ● HMIS Basic Functions IV. HMIS Cultures V. Conclusion Notes Chapter Questions Mini-Case: MinuteClinic 3 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 56918_CH01_Secondpass.qxd:Tan 3/18/09 2:57 PM Page 4 4 H EALTH M ANAGEMENT I NFORMATION S YSTEMS Scenario: Key Trends Contributing to the Merging of Enterprise and Health Information Exchange Models1 Informatics Corporation of America (ICA), with its website (www.icainformatics.com) offering insightful materials for the interested readers, is a health information technology (HIT) organi- zation whose mission is to provide clinicians and healthcare providers with more or less seam- less access to information extracted from various uncoordinated systems for patient diagnosis and evaluation. Recently, ICA sent out a press release to various stakeholders in the healthcare informatics (HI) community outlining five key trends shaping the development of health infor- mation exchanges (HIE) among large healthcare organizations: 1. The growing impetus for healthcare provider connectivity. 2. An increasing focus on the need to manage chronic diseases. 3. Increased patient expectation of personal involvement in the care process. 4. Market pressures for improved hospital–physician alignment. 5. Advances in technology facilitating system interoperability. With an increasing number of baby boomers and the elderly constituting the U.S. population, it is envisaged that these trends will become more prevalent for U.S. healthcare services organi- zations in the near future. “These trends highlight the benefits which community-based healthcare models can offer all constituents—physicians, patients, and healthcare providers across the continuum of care,” says Gary M. Zegiestowsky, chief executive officer (CEO) of ICA. “The gap between traditional en- terprises and HIE is closing, with growing connectivity for physicians and ultimately the entire healthcare community in certain cities or regions. We believe this is signaling a paradigm shift that has both near- and long-term implications for healthcare and HIT.” “In order to keep pace with these trends,” Zegiestowsky continues, “physicians in every com- munity first need intuitive, proven technology solutions aligned with clinical workflow to speed the adoption of electronic health records. Moving toward patient-centric care will be possible when all providers across the broad spectrum of care are able to access and utilize a unified pa- tient record in combination with tools that enable better care.” ICA’s response to this growing trend is the use of an exchange platform created for both en- terprise and HIT systems, such as the A3Align Solution™. For 10 years, practicing physicians and informatics professionals from Vanderbilt Medical Center have developed this technology, which has eventually been installed at Bassett Healthcare’s enterprise comprising four hospitals and 27 clinics in Cooperstown, New York. A3Align Solution will also be implemented by both the Montana and Northwest Healthcare for HIE. In addition, Vanderbilt distributed this same technology across its 40 facilities in the Mid-South eHealth Alliance, a successful HIE in west- ern Tennessee. With these major trends encouraging HIE among healthcare services organizations, what do you believe are the benefits of having all of your health information made freely accessible and interchangeable among all of your caregivers? What would be your worst fear? © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 56918_CH01_Secondpass.qxd:Tan 3/18/09 2:57 PM Page 5 I. INTRODUCTION 5 I. Introduction As we enter this world, how did we become aware and conscious of who we are, and of things that surround us? How did we learn about the myriad ideas, sights, sounds, and smells and the many events that we see, hear, feel, and witness in the surrounding space in which we live and breathe for each day of our lives? Aren’t “data” and “information” the essential constructing blocks in our lives? Isn’t “knowledge” the central intellectual core that links everything else to form meanings, interpretations, and actions? Aren’t “information systems” innate in each and every one of us as human beings who find it so very natural to process incoming streams of “stimuli” continuously, seamlessly, and automatically—irrespective of how cognitively complex these stimuli may at first appear to be? Seemingly, all of us have already been introduced some- what to the subject of health management information systems (HMIS) even from the first day of birth as we “woke up” from our “deep sleep” inside our mother’s wombs, most likely, within the confines of a healthcare or maternal health-related facility. The field of HMIS is inherently complex. Take the myriad terminologies employed in this text as an example. There are subtle differences even with major terminologies used to describe the field. For instance, health management information systems (HMIS), which is the term used liberally throughout the first edition of this text, has, in and of itself, a managerial slant, and whereas healthcare information technology (HCIT or health IT–HIT) has a technology slant, health information systems (HIS) or healthcare information systems (HCIS) may be interpreted as the umbrella term with a systems or information systems connotation. Informatics is another commonly used term among European researchers, and health informatics or clinical informatics generally refers to the application of data methods in medicine, healthcare services, and clinical practices. For this reason, some authors, as will become apparent in the latter part of the text, use the terms health informatics (HI) and medical informatics (MI) as well as e-health (electronic health). Thus, in this edition of the HMIS text, for the sake of simplicity and to further reduce complexities for less sophisticated readers, we allow the usage of these several and diverse termi- nologies to be more or less interchangeable among the works accumulated by the different con- tributing authors and accompanying editors. Also, to ease the disruption in the readings and simplify the editing process, we have generally dropped the “s” that is typically appended to many of these acronyms to create the plural sense and simply use these acronyms in more or less the plural sense unless it is specifically preceded with an article such as “a” or “the” when attach- ing a verb to the specific acronyms or using it as a descriptive adjective, as in “the HMIS” field. More importantly, the HMIS conceptualization we have drawn in this text comes from an eclectic well of traditionally established as well as newer disciplines. Academic researchers, edu- cators, and practitioners from diverse disciplines—including, but not limited to, electrical and computing engineering, industrial engineering, clinical and management engineering, nursing and allied health, health informatics, health management, organizational behavior, computer science, and cognitive science—have all contributed, in one form or another, to the develop- ment and accumulation of HMIS knowledge domains. Indeed, as early as the 1960s, cognitive scientists have modeled the human cognition as an information processing system. Here, the human brain is perceived to act just like the computer, © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 56918_CH01_Secondpass.qxd:Tan 3/18/09 2:57 PM Page 6 6 H EALTH M ANAGEMENT I NFORMATION S YSTEMS and experiments conducted on the human stimuli-response system inform us of the familiar story of how different external stimuli (information) can exert different patterns of resulting or induced behaviors among the human observers. In other words, the information systems within humans are exemplified by the cognitive activities recurring within the human brain. In the HMIS analogy, the information processors are likened to the eyes and minds of the health organization. In this newly revised edition, the term adaptive HMIS has been used specifically to empha- size the need for a flexible approach to health information administration and management. HMIS students must learn how to apply information science, information systems, and health informatics concepts from an adaptive but integrated health management perspective. More generally, this text aims to provide the students with a state-of-the-art managerial perspective of health information technological systems in the coming years so that they are well prepared to face the many challenges of acquiring and applying new forms of HCIT for healthcare services management purposes in this century and beyond. In this first chapter, we briefly cover the HMIS evolution, its underlying architecture, and its basic functions. We then close the chapter with a brief survey of the role HMIS technology plays in driving today’s healthcare and healthcare- related